Objective  To investigate the difference of effectiveness between medial-lateral approach and posteromedian approach in the release of elbow stiffness after distal humeral fracture surgery. Methods  A retrospective analysis was conducted on the clinical data of 41 patients with elbow stiffness following medial and lateral plate fixation for distal humerus fractures, admitted between January 2021 and June 2023 and meeting selection criteria. Patients were divided into the combined medial-lateral approach release group (study group, 20 cases) and the posterior midline approach release group (control group, 21 cases) based on surgical approach. Baseline characteristics including age, gender, affected side, body mass index, disease duration, and preoperative extension angle, flexion angle, range of motion, visual analogue scale (VAS) pain score, Mayo elbow performance score, ulnar nerve symptoms, and heterotopic ossification showed no significant differences between groups (P>0.05). The operation time, intraoperative blood loss, and complication incidence were recorded and compared between groups. Clinical efficacy was evaluated using pre- and postoperative Mayo score, VAS score, elbow extension/flexion angles, and range of motion on the affected side. Statistical analysis focused on changes in these indicators relative to preoperative values. Results  There was no significant difference in operation time and intraoperative blood loss between the two groups (P>0.05). Patients in both groups were followed up 15-36 months, with a mean of 23.8 months; there was no significant difference in the follow-up time between the two groups (t=−1.542, P=0.131). In the control group, 1 patient had obvious subcutaneous hematoma and 5 patients had poor wound healing within 2 months after operation, all of which were cured by symptomatic treatment, while no related complications occurred in the study group, and the difference was significant (P<0.05). At last follow-up, 2 patients in the study group and 3 patients in the control group had mild symptoms of ulnar nerve numbness, and there was no significant difference in the incidence of ulnar nerve symptoms (P>0.05). All patients had no recurrence or new onset of heterotopic ossification, no skin necrosis or reoperation due to complications. At last follow-up, elbow extension angle, flexion angle, flexion-extension range of motion, VAS score, and Mayo score significantly improved in both groups when compared with the preoperative ones (P<0.05). There was no significant difference between the change values in elbow extension angle and VAS score between the two groups (P>0.05); the change values in flexion angle and Mayo score in the study group were significantly better than those in the control group (P<0.05). Conclusion  The medial-lateral approach can release the elbow stiffness and concurrently remove the medial, lateral, or posterior lateral steel plates. The incision minimizes disruption to rehabilitation exercises and reduces complications like inadequate wound healing, ultimately leading to improved treatment outcomes.

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